BACKGROUND: People with end-stage renal disease are at high risk for bone fracture. Less is known about fracture risk in milder chronic kidney disease and whether chronic kidney disease-associated fracture risk varies by sex or assessment with alternative kidney markers. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 10,955 participants from the Atherosclerosis Risk in Communities (ARIC) Study followed up from 1996 to 2011. PREDICTOR: Kidney function as assessed by creatinine-based estimated glomerular filtration rate (eGFRcr), urine albumin-creatinine ratio, and alternative filtration markers. OUTCOMES: Fracture-related hospitalizations determined by diagnostic code. MEASUREMENTS: Baseline kidney markers; hospitalizations identified by self-report during annual telephone contact and active surveillance of local hospital discharge lists. RESULTS: Mean age of participants was 63 years, 56% were women, and 22% were black. During a median follow-up of 13 years, there were 722 incident fracture-related hospitalizations. Older age, female sex, and white race were associated with higher risk for fracture (P<0.001). The relationship between eGFRcr and fracture risk was nonlinear: <60mL/min/1.73m(2), lower eGFRcr was associated with higher fracture risk (adjusted HR per 10mL/min/1.73m(2) lower, 1.24; 95% CI, 1.05-1.47); there was no statistically significant association for ≥60mL/min/1.73m(2) in the primary analysis. In contrast, there was a graded association between other markers of kidney function and subsequent fracture, including albumin-creatinine ratio (HR per doubling, 1.10; 95% CI, 1.06-1.14), cystatin C-based eGFR (HR per 1-SD decrease, 1.15; 95% CI, 1.06-1.25), and 1/β2-microglobulin (HR per 1-SD decrease, 1.26, 95% CI, 1.15-1.37). LIMITATIONS: No bone mineral density assessment; one-time measurement of kidney function. CONCLUSIONS: Both low eGFR and higher albuminuria were significant risk factors for fracture in this community-based population. The shape of the association in the upper ranges of eGFR varied by the filtration marker used in estimation.
BACKGROUND:People with end-stage renal disease are at high risk for bone fracture. Less is known about fracture risk in milder chronic kidney disease and whether chronic kidney disease-associated fracture risk varies by sex or assessment with alternative kidney markers. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 10,955 participants from the Atherosclerosis Risk in Communities (ARIC) Study followed up from 1996 to 2011. PREDICTOR: Kidney function as assessed by creatinine-based estimated glomerular filtration rate (eGFRcr), urine albumin-creatinine ratio, and alternative filtration markers. OUTCOMES: Fracture-related hospitalizations determined by diagnostic code. MEASUREMENTS: Baseline kidney markers; hospitalizations identified by self-report during annual telephone contact and active surveillance of local hospital discharge lists. RESULTS: Mean age of participants was 63 years, 56% were women, and 22% were black. During a median follow-up of 13 years, there were 722 incident fracture-related hospitalizations. Older age, female sex, and white race were associated with higher risk for fracture (P<0.001). The relationship between eGFRcr and fracture risk was nonlinear: <60mL/min/1.73m(2), lower eGFRcr was associated with higher fracture risk (adjusted HR per 10mL/min/1.73m(2) lower, 1.24; 95% CI, 1.05-1.47); there was no statistically significant association for ≥60mL/min/1.73m(2) in the primary analysis. In contrast, there was a graded association between other markers of kidney function and subsequent fracture, including albumin-creatinine ratio (HR per doubling, 1.10; 95% CI, 1.06-1.14), cystatin C-based eGFR (HR per 1-SD decrease, 1.15; 95% CI, 1.06-1.25), and 1/β2-microglobulin (HR per 1-SD decrease, 1.26, 95% CI, 1.15-1.37). LIMITATIONS: No bone mineral density assessment; one-time measurement of kidney function. CONCLUSIONS: Both low eGFR and higher albuminuria were significant risk factors for fracture in this community-based population. The shape of the association in the upper ranges of eGFR varied by the filtration marker used in estimation.
Authors: Lesley A Inker; John Eckfeldt; Andrew S Levey; Catherine Leiendecker-Foster; Gregory Rynders; Jane Manzi; Salman Waheed; Josef Coresh Journal: Am J Kidney Dis Date: 2011-08-19 Impact factor: 8.860
Authors: M Jadoul; J M Albert; T Akiba; T Akizawa; L Arab; J L Bragg-Gresham; N Mason; K-G Prutz; E W Young; R L Pisoni Journal: Kidney Int Date: 2006-08-23 Impact factor: 10.612
Authors: Lesley A Stevens; Christopher H Schmid; Tom Greene; Liang Li; Gerald J Beck; Marshall M Joffe; Marc Froissart; John W Kusek; Yaping Lucy Zhang; Josef Coresh; Andrew S Levey Journal: Kidney Int Date: 2008-12-31 Impact factor: 10.612
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Anda Gonciulea; Ruibin Wang; Keri N Althoff; Michelle M Estrella; Deborah E Sellmeyer; Frank J Palella; Jordan E Lake; Lawrence A Kingsley; Todd T Brown Journal: J Acquir Immune Defic Syndr Date: 2019-07-01 Impact factor: 3.731
Authors: Howard A Fink; Tien N Vo; Lisa Langsetmo; Joshua I Barzilay; Jane A Cauley; John T Schousboe; Eric S Orwoll; Muna T Canales; Areef Ishani; Nancy E Lane; Kristine E Ensrud Journal: J Bone Miner Res Date: 2017-02-21 Impact factor: 6.741
Authors: Pedro Monteiro; Richard M Bergenstal; Elvira Toural; Silvio E Inzucchi; Bernard Zinman; Stefan Hantel; Sanja Giljanovic Kiš; Stefan Kaspers; Jyothis T George; David Fitchett Journal: Age Ageing Date: 2019-11-01 Impact factor: 10.668
Authors: Junichi Ishigami; Morgan E Grams; Alexander R Chang; Juan J Carrero; Josef Coresh; Kunihiro Matsushita Journal: Am J Kidney Dis Date: 2016-11-22 Impact factor: 8.860
Authors: Shoshana H Ballew; Yan Chen; Natalie R Daya; Job G Godino; B Gwen Windham; Mara McAdams-DeMarco; Josef Coresh; Elizabeth Selvin; Morgan E Grams Journal: Am J Kidney Dis Date: 2016-11-22 Impact factor: 8.860
Authors: Corinne E Joshu; John R Barber; Josef Coresh; David J Couper; Thomas H Mosley; Mara Z Vitolins; Kenneth R Butler; Heather H Nelson; Anna E Prizment; Elizabeth Selvin; Janet A Tooze; Kala Visvanathan; Aaron R Folsom; Elizabeth A Platz Journal: Cancer Epidemiol Biomarkers Prev Date: 2017-12-20 Impact factor: 4.254
Authors: J I Barzilay; P Bůžková; H A Fink; J A Cauley; J A Robbins; P S Garimella; D I Jalal; K J Mukamal Journal: Osteoporos Int Date: 2016-06-01 Impact factor: 4.507
Authors: Yejin Mok; Shoshana H Ballew; Yingying Sang; Josef Coresh; Corinne E Joshu; Elizabeth A Platz; Kunihiro Matsushita Journal: Am J Epidemiol Date: 2020-09-01 Impact factor: 4.897